Abstract
Abstract
Background: Hand washing with soap is crucial for infection transmission prevention. However, despite its effectiveness in reducing infections, globally the proportion of individuals who comply is low at only 19%, varying between developed (48-72%) and developing countries (5-25%). In Africa, basic hand washing facility coverage is at 15%, and in Kenya, the same is estimated at 18%. During the COVID-19 pandemic, awareness and hand washing practices increased globally including Kenya. However, hand-washing adoption often declines soon after crises/pandemics. Informal settlements, such as Viwandani, are harder hit by handwashing challenges because of limitations in access to water and handwashing facilities. Moreover, these communities are more vulnerable to other non-hygiene-related infectious diseases. Data on hand washing practices is sparse more so among populations living in informal settlements. Also, there is need to identify interventions for sustained hand washing with soap in these communities.
Objectives: To explore handwashing practice among the slum population, in a post-pandemic era. Specifically, the study will 1) assess adherence to and techniques of handwashing used in main hand washing hotspots in slum residents of Viwandani, Nairobi, 2) assess perceptions, facilitators, and barriers to sustaining adherence to hand washing with soap after COVID-19 by slum residents in Viwandani, Nairobi, 3) explore the motivation and mechanism through which hand washing with soap can be sustained among some slum residents in Viwandani, Nairobi and 4) assess availability and readiness of handwashing facilities at identified hand washing hotspots in Viwandani, Nairobi.
Methods: This will be a qualitative study using direct observation, key informant interviews (KIIs), focus group discussions (FGDs), and in-depth interviews (IDIs) to collect information on adherence to and techniques of handwashing, perceptions, facilitators, and barriers to sustaining handwashing with soap, as well as the motivations and mechanisms through which handwashing with soap can be sustained including availability and readiness of handwashing facilities. The work will conclude with a consultative workshop to propose a pilot concept for sustained hand washing with soap in Viwandani.
First, the research team, with the assistance of the community advisory committee (CAC) members, familiar with the local set up will identify hot spots for handwashing. The CAC is a dedicated group that helps identify local health needs and develops ways to address those needs using community approach. The CAC is composed of members elected by respective constituent groups that they represent. The members represent government, local leaders/village leaders, the youth, women, older persons, school administrators, healthcare providers, faith-based organizations/community-based organizations/local non-governmental organizations, community health volunteers, media/education and entertainment organizations, religious groups and people living with disabilities.
Then, we will conduct covert observations at the identified hotspots across Viwandani, focusing on both handwashing facilities and their users. Each hotspot will have two observation sessions in which several individuals may be observed, one session in the morning (9:00 AM to 1:00 PM) and another in the afternoon (1:00 PM to 5:00 PM). From each observation session, we will purposively select one individual for IDI, meaning that we will conduct 2 in-depth interviews from each observation site. In addition, we will engage CAC members in FGDs to further explore the community motivation and the mechanisms for sustained hand washing with soap. We will also gather additional insights from KIIs drawn from individuals representing facilities in the hotspot list. These will be institutional leaders or owners of these hotspots or focal persons who are well informed about hand washing with soap. Lastly, we will convene a consultative workshop bringing together representatives from the County health officials, local administration,interview participants, CAC, and representatives of the facilities within the hotspots to collaboratively propose a pilot concept for sustained hand washing with soap in Viwandani. We will conduct thematic analysis of the data.
Significance: In resource-constrained slum environments, where costly interventions like sanitation upgrades may not be feasible and the risk for transmission of infectious diseases is high, it is crucial to understand how existing resources are utilized for handwashing with soap. This project will generate insights into current practices, identifying factors that influence the use of available resources, explore motivation mechanisms and assess availability and readiness of facilities for hand washing with soap in Viwandani. The findings will inform the design or improvement of sustainable handwashing interventions, contributing to more effective disease prevention strategies.
Duration: 12 months (March 2024 to February 2025)
Budget: USD 10,000
Lay summary
Washing hands with soap is important for preventing the spread of pathogens. But not many people around the world do it regularly - only about 19%. This varies depending on where you live, with richer countries having higher rates (around 48-72%) and poorer countries having lower rates (about 5-25%). During the COVID-19 pandemic, governments including Kenyan, ran campaigns to get people to wash their hands more, and they set up lots of handwashing stations. More people started washing their hands because they feared getting sick. As a result, besides prevention of COVID-19 transmission, additional benefits were realized including reduction of diarrheal and other respiratory infections. But in the past, when there have been outbreaks of diseases, people start washing their hands more, but then they stop again soon after. A survey in Nairobi found that after six months, most of the handwashing stations were still working, and lots of people were using them properly. But a year later, fewer people were using them, and some of the stations were abandoned.
Through this study, we would like to understand how people in the slums of Viwandani in Nairobi are washing their hands after the COVID-19 pandemic. We will work with the community to come up with ways to encourage people to keep washing their hands regularly. Specifically, we will engage CAC members to identify hotspots for handwashing with soap in their community, then observe people in the identified hotspots to see how they wash their hands in places where they're supposed to. Out of those that we observe, we will pick out some and talk to them to find out what they think about washing their hands with soap and what makes it hard for them to keep doing it, as well as what motivates some people to keep washing their hands and how we can help others do the same. Additionally, we will hold discussions with the CAC team that did the hotspot mapping to gather more information on the community perspective of hand washing with soap. We will also talk to key informants to gather further insights. Finally, we will hold a workshop to bring together representatives from the County health officials, local administration, interview participants, the CAC, and representatives from the facilities in the hotspot list. They will collaboratively propose a pilot concept for Viwandani community that can encourage regular hand washing with soap. We will analyze the data to find common themes and insights.
This study appreciates that in poor areas like slums, it's not easy to do big things like upgrade sanitation systems. So, it's important to focus on simple things like washing hands with soap, which can help stop diseases from spreading. But even though washing hands is cheap and effective, not many people keep doing it regularly. This study will help us understand why and propose ways to fix it, as suggested by the community itself.
The study will last for 12 months, from March 2024 to February 2025.
The budget for the study is $10,000.
